The instant invention relates to surgical pressure dressings and more particularly to a pressure dressing for use in the treatment of an auricular hematoma or other ear injury requiring pressure on the injured area.
An auricular hematoma is typically caused by a blunt trauma or shearing force to the external ear that disrupts the adherence of the perichondrium or skin of the ear to the underlying cartilage and the subsequent filling of the subperichondrial space with blood. Most auricular hematomas occur in the concavities on the anterior side of the ear because the anterior skin is closely fixed and firmly adherent to the underlying cartilage and therefore it will tend to shear off rather than slide over the cartilage. In contrast, the posterior skin of the ear is separated from the cartilage by muscle, fat and other tissue and is only loosely fixed to the cartilage. The posterior skin is therefore much more resistant to the shearing forces than the anterior skin.
Blunt trauma or shearing forces to the ear are typically inflicted during contact sports, such as wrestling and boxing. Because of the repeated trauma to the ear in these sports, auricular hematomas in wrestlers and boxers have traditionally been quite difficult to treat. In addition, many active athletes refuse to take the time off that is necessary for the hematoma to properly heal and for the skin to reattach to the cartilage. In the past it was common for wrestlers to line up after a match to have their ears "needled" to aspirate the accumulated blood. Many athletes refused the treatments because of excessive pain and as a result the untreated injuries usually resulted in a thickened deformity of the ear known as "cauliflower ear".
The standard approach in the treatment of an auricular hematoma is aspiration of the hematoma by a large bore needle, reapposition of the skin to the cartilage, prevention of hematoma reoccurrence, and the avoidance of infection. Most of the problems in the treatment of an auricular hematoma ar encountered with reapposition of the perichondrium to the underlying cartilage and the prevention of hematoma reoccurrence. Several surgical procedures have heretofore been known, but few have met with anything but limited success. One such procedure is to suture pressure dressings to the ear on opposing sides of the injured portion thereof. The pressure dressings are positioned on opposing sides of the ear and the sutures are passed through the cartilage to gently squeeze the skin and cartilage together between the dressings. This method often does not provide an evenly distributed pressure over the injured area and as a result, blood can reaccumualte under the skin to reform the hematoma. Reformation of the hematoma requires repeated aspiration of the accumualted blood which in turn increases the chance of infection. In addition, the procedure can sometimes be painful because several sutures are typically required to cover the entire area of the hematoma. Still further, the pressure dressing must be left in position for several weeks until the skin has reattached. For athletes who continue to participate in contact sports such as wrestling, these pressure dressings make the ear vulnerable to re-injury. The exposed dressing can easily be torn out during contact activity even if the ear is protected by head gear.
Another procedure which has had some success is to suture the detached skin and underlying cartilage together with absorbable mattress sutures. This procedure provides an evenly distributed pressure over the area of the injury and does not require the bulky pressure dressings of the previously described procedure, but it does have several disadvantages. The procedure requires several through and through sutures to completely cover the area of the hematoma and this can often be painful. The sutures can also irritate the ear tissue if they do not become absorbed quickly enough.
In addition to use in the treatment of auricular hematomas, pressure dressings are also used in many other treatments of the ear, such as the covering and compressing of an acute wound to the ear, the excision of a skin cancer, the placement of a skin graft, the repair of a torn earlobe, the treatment of a localized burn, or the excision of a keloid which can form on the earlobe or other portions of the ear after piercing thereof.